Understanding AIDS
Any action to confront the terrible problems of the AIDS epidemic must be welcomed--although, sad to say, many of the responses do more to reveal the inadequacy of programs than to offer reassurance that the responses are effective.
At the local level, the Los Angeles County Board of Supervisors has followed its expansion of the testing program with a declaration of support for hospices as an alternative to hospital care. The hospice declaration was devoid of support funding, however, even though home and hospice programs can be operated at one-tenth the cost of the present in-hospital program. Part of the problem lies with limits on the use of Medi-Cal funds for non-hospital care, and that problem is being addressed with legislation in Sacramento. But that has not prevented San Francisco from funding an effective hospice and home-care program.
At the state level the omnibus AIDS bill, AB 87--the first in the nation to seek to implement the recommendations of the U.S. surgeon general--is caught in a crossfire of special interests. Some business interests oppose anti-discrimination elements because they want to be free to cancel health-insurance coverage for AIDS victims. Some real-estate interests want to manipulate it to weaken anti-discrimination ordinances on housing already in effect in Los Angeles and San Francisco. The school-board lobby is fighting a requirement for consultation with medical officials before any student with AIDS is barred. This quibbling is serving only to delay the creation of an effective state commission to get on with the urgent task of coordinating the work while demonstrating the kinds of discrimination that the bill would ban.
At the federal level President Reagan finally this week, after a year of silence, has mentioned AIDS by name. He spoke in favor of improved education. And he implemented an agreement ending a quarrel between French and American scientists over the discovery of the AIDS virus, which in turn will free new resources for the difficult task of developing a vaccine. That will take years, the experts tell us. In the meantime, there is no known cure.
The lives of some AIDS victims are being prolonged by the drug AZT. The Food and Drug Administration has moved with unusual speed to make it available under carefully controlled circumstances, but the FDA is wisely resisting pressure to shortcut research on other treatments and experimental vaccines. The evidence suggests that carelessness at the early stages of testing and development could do more harm than good. But even AZT, because of its treatment cost of about $10,000 a year, will remain beyond the reach of thousands of AIDS victims who are not eligible for Medicaid (Medi-Cal in California) or who do not have health insurance containing provisions for prescription-drug coverage or coverage for “catastrophic” treatment costs. That is an inequity that must be quickly corrected.
It is clear, from the limited responses at all levels, that the dimensions of this epidemic are not fully appreciated either by the public or by government leaders. AIDS is still seen by many as an isolated problem for drug addicts and homosexuals that, as one county official said, is therefore not a responsibility of society at large. That sort of bigoted ignorance only enhances the risks while betraying an unworthy insensitivity to tens of thousands of victims of the disease. This is a global problem. Everyone can be at risk. The control of the disease, the care of those infected and the search for a cure will be enormously costly. The risks will diminish only as that is understood.
